Replies to LegCo questions

LCQ4: Organ donation and transplant

Following is a question by the Dr Hon Elizabeth Quat and a reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (October 28):

Question:

Recently, a 19-year-old young girl in a critical condition suffering from pulmonary hypertension died while waiting in vain for suitable lungs for transplant. Also, only at the last minute did a 46-year-old man with liver failure receive a liver transplant to gain a new lease of life. It has been reported that the organ donation rate in Hong Kong is lower than those in other regions. In 2011, there were about 35 deceased organ donors per million population (pmp) in Spain, 17 donors pmp in the European Union but less than five donors pmp in Hong Kong. While the demand for organ transplant in Hong Kong has been increasing year after year, organs available for transplant are in acute shortage. In this connection, will the Government inform this Council:

(1) as there are currently only 174 000 registrations recorded on the Centralised Organ Donation Register, how the authorities will step up efforts in promoting the message of organ donation, and whether they will arrange staff to proactively approach members of the public, at places where they apply for identity cards, passports, driving licences and public library cards and donate blood, to invite them to consider signing an organ donation card; if they will, of the details; if not, the reasons for that;

(2) as there are currently only nine organ transplant coordinators in Hong Kong, who are responsible for liaison work on organ transplant matters at around 40 public hospitals throughout Hong Kong, whether the authorities will increase the manpower such that at least one coordinator is provided for each public and private hospital, so that apart from persuading families of persons who have just passed away to donate the organs of the deceased, they may also devote more efforts in promoting organ donation among staff, patients, etc. in hospitals and conduct registration for them; if they will, of the details; if not, the reasons for that; and

(3) whether it will implement a new policy to increase organ donation rate, such as by stipulating that where deceased persons have not raised any objection before death to organ donation, they will be deemed to have given consent to donate their organs for transplant after death, as well as enacting legislation to provide that organ donation cards have a legal effect similar to that of wills, in that unless the signers have changed their mind before death, other persons (including their families) do not have the right to object, after the signers have passed away, to the donation of their organs for transplant; if it will, of the details; if not, the reasons for that?

Reply:

President,

For patients suffering from end-stage organ failure, organ transplant is their hope for gaining a new life. Organ transplants in Hong Kong, be it from cadaveric or living donations, are subject to regulation under the Human Organ Transplant Ordinance, which aims mainly to ensure that no commercial dealing is involved in the organs for transplant.

Organ donation and transplant, and eventually whether patients can be saved, depend on a number of factors. The Hospital Authority (HA) has put in place mechanisms to handle and co-ordinate the clinical aspects involved in the process. However, one of the most important factors, which is beyond our direct control, is the attitude of the general public towards organ donation. In this regard, it is Government's policy to gradually inculcate a culture of organ donation in the community with a view to reducing reluctance or hesitation of individuals and family members in donating organs.

Hong Kong has seen an overall increase in organ donation rate. It rose from about four donors pmp in 2005 to about 6.1 pmp in 2013, which is higher than that of other developed economies in Asia such as Malaysia (0.5) and Japan (0.66), but remains lower than some Western countries. Organ donation rate is affected by a number of factors, including demographic structure and death rate, attitude of individuals and their family members, and clinical factors. Given the differences in background, customs, culture and individual circumstances, we cannot make direct comparison.

Our reply to the various parts of the question is as follows:

(1) At present, members of the public may register their wish to donate organs after death through the Centralised Organ Donation Register (CODR) managed by the Department of Health (DH) by mail or through Internet. Currently, more than 179 000 registrations are recorded in the CODR. Besides, members of the public can carry signed organ donation cards or express their wish to healthcare workers. In the event that a deceased person had not indicated his/her wish by signing the organ donation card or registering in the CODR, his/her organs can still be donated with the consent of his/her family members.

To impress upon the general public the importance of organ donation and to gradually inculcate a culture that is receptive to and appreciative of organ donation, the DH has been making promotional efforts on different fronts in collaboration with the HA and non-governmental organisations (NGOs).

The DH launched the CODR in November 2008 to encourage the public to register their wish to donate their organs after death. In recent years, the DH has introduced an IT platform to facilitate members of the public to register as organ donors. The DH has also taken the following promotional measures:

(a) establishing an institution-based network by inviting public bodies, private companies and NGOs to work in collaboration with the Government to promote organ donation, and to encourage registration in the CODR in institutions. There are currently over 300 supporting organisations;

(b) enhancing public understanding and acceptability of organ donation through public education activities such as exhibitions and seminars. In the past three years, the DH organised about 170 seminars and exhibitions in various places such as hospitals, government buildings / offices, Immigration Tower etc.;

(c) launching promotional activities on television, radio, the Internet and other media; and

(d) encouraging public participation through electronic means such as setting up an Organ Donation Facebook Fan Page to enhance the promotion of organ donation among the younger population.

Since 2008, we have distributed more than 2.1 million leaflets with CODR registration forms. The DH also arranged distribution of promotional leaflets and CODR registration forms at blood donor centres. We will consider arranging distribution of such promotional leaflets or materials at other locations.

To recognise the charitable acts of organ donors and their families, the Government has established the Garden of Life in Kowloon Park. Characterised by special landscape and architecture, the design of the garden echoes the theme "Light Up Lives" of organ donation.

Over the years, the DH has organised various activities to celebrate the anniversaries of the launch of CODR and further promote organ donation. To celebrate the seventh anniversary of the launch of CODR, the DH will, in collaboration with the Hong Kong Medical Association, the HA, Hong Kong Society of Transplantation and Hong Kong Liver Foundation, organise talks in November, to further promoting registration for organ donation among the public through joint efforts with primary care doctors.

(2) The duties of transplant coordinators of the HA include the following three areas:

1. Approach families of brain stem dead patients who may be potential donors and explain to them the details of organ donation in the hope that they will give consent.

2. With the HA, promote organ donation among healthcare staff to raise their awareness of it.

3. Provide support and co-ordination for external organ donation promotional activities.

At present, the HA has seven transplant co-ordinators. Regarding the work of approaching families of brain stem dead patients mentioned in item (1) above, effective contacts have generally been made. As for items (2) and (3), the HA has recently increased its establishment to nine transplant co-ordinators in 2015-16 to strengthen internal and external promotion of organ donation. As such work virtually requires various professional community partners (including the DH and other interested community and professional groups) to collaborate, transplant co-ordinators play a supportive and co-ordinating role to create a positive atmosphere for organ donation in the whole community. The HA will review the effectiveness of the latest enhancement and the manpower of transplant co-ordinators as appropriate.

(3) The Government seeks to enhance public understanding and acceptance of organ donation through different approaches, including strengthening education and publicity.

Adopting a legislative approach like drawing on overseas experiences to introduce mechanisms such as "automatic organ donation" and "opting out systems", or to provide "organ donation card" with legal effect so that it can form part of a will, are very different from the existing organ donation regime. Under the existing regime, family members of organ donors have the right to refuse the request for organ donation on behalf of the donors. We must respect their wishes. Before implementing any new proposals, we should ensure that they are acceptable to the public, and a fair, transparent and widely acceptable mechanism will be developed.

We will continue to discuss with the professional sectors and interested parties in the light of the recent discussions on organ donation in the community and duly consult the public before making any substantial changes to the existing regime.

The Government plans to assess more in-depth the public's understanding and acceptance of organ donation via the Census and Statistics Department's Thematic Household Survey. In the meantime, the DH will continue to step up its efforts in promoting organ donation.

Thank you, Mr President.

Ends/Wednesday, October 28, 2015
Issued at HKT 17:23

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